The idea that when centers perform more of a procedure, such as endovascular thrombectomy for acute ischemic stroke, they more often do it better is intuitively plausible, which helps makes these findings believable. It’s also a relationship we’ve already seen for other types of endovascular therapies. What this study did not address were other factors beyond case volume also might also make important contributions to outcome, such as the speed of treatment delivery.

It’s been only 4 years since endovascular thrombectomy became standard of care in early 2015 for treating selected patients with an acute ischemic stroke. Since then, the focus of stroke clinicians has largely been on increasing the number of locations where patients could receive this important treatment. There remains a shortage of endovascular availability in many rural U.S. regions. The precedent clearly exists from other types of endovascular interventions for professional societies to set volume minimums that can sometimes be a surrogate marker of a center having and maintaining an optimal level of competence. But I don’t believe that we currently have adequate availability of endovascular stroke therapy to take this step. If we set a volume minimum now, it could deny treatment access to a significant number of patients.

Volume thresholds for endovascular stroke programs will come eventually, but for the time being our focus should be on insuring wide access to endovascular treatment.

Bruce Ovbiagele, MD, a neurologist and chief of staff for the San Francisco Veteran Affairs Health Care System, made these comments in an interview. He reported no disclosures.